This feature is available to Subscribers Only

The special communication article by Nicole Saitta, MA, and Samuel D. Hodge, Jr, JD, in the May issue (“Efficacy of a Physician's Words of Empathy: An Overview of State Apology Laws.” 2012;112[5]:302-306) caught my attention on a couple of fronts.

In nearly 20 years of practice, I have never bought into the early guidance I received from some of my teachers that a physician should never apologize. I have consistently offered an “I'm sorry” to my patients and their families whenever the circumstances warranted such words. Such an expression, when it is truthful, is valuable simply for that reason—because it is the truth. Some patients may not want to hear it, but they do respect and accept it. My feeling has always been that the unique relationship of physician and patient already has enough asymmetry built into it without physicians refusing to humble themselves should circumstances warrant.

An example of such a circumstance would be a medication error. A filed incident report, along with an apology, serves to assuage much of the patient's concerns, letting the patient know that the mistake was recognized and steps have been taken to mitigate the chances of similar mistakes in the future. Another example would be a delay in care caused by an unclear or confusing clinical picture. An apology and explanation for the delay can go a long way toward reducing the anger felt by the patient—an anger often stemming from the complexity of the medical system that the patient does not understand and the clinical detachment that the patient may sense in an emotionally and mentally overloaded caregiver. The main point to keep in mind is that the mistake cannot be undone, but the mistake itself is not nearly as troublesome to the patient as is the sense that the caregiver is cavalier or indifferent to the event.

My patients have always responded maturely to the truth by acknowledging that they respect my honesty. I have had a few unsettled nights wondering if my words would be used to determine my guilt in a tort proceeding, but those fears have been, so far, unwarranted. Patients know that physicians are not superhumans. They know that we make mistakes. What they want is not perfection, but the ability to trust us as acting in their best interests and to the best of our abilities when they are in serious need. The basis for that trust is the unembellished truth.

Aside from the glaringly obvious notion that people do not get as angry with truthful physicians as they do with liars, the other issue that the Saitta and Hodge article reminded me of is the peculiar habit of some physicians to attempt to “indemnify” themselves by rendering comments about care that could have been provided had the patient arrived sooner. One case that comes to mind involves a patient I knew who was seriously injured. Unfortunately, the severity of the injury was not recognized early enough to correct the problem, resulting in the loss of career for the patient. This patient told me that when she arrived at the surgeon, the first thing that the surgeon said was, “If you had only arrived here ‘X’ hours ago, I could have prevented this.”

Of course, the patient asked me what I thought of this matter. Having had no input into this individual's care, I did the best thing that I could and replied, “I wasn't there, so I cannot comment. I trust that physicians do their best with what they see when they see it, and it is not for me to speculate, but to care for you now.”

Sadly, the resulting lawsuit ruined the career of an otherwise excellent physician who ended up being collateral damage in the pool of named defendants.

Physicians who seek to mitigate their own liability in what might be a bad situation for the doctors who were involved prior to referral might do well to remember that what goes around comes around. Speculation is not fact, and it does nothing to fix a disaster. It only ensures that greater folly will occur.

I have always taught my students and residents that “I don't know” is an acceptable answer when it is the truth. To the extent that patients can accept a humble “I am sorry” when circumstances warrant it, I am quite certain that they will also accept “I don't know,” especially when physicians are clearly not in a position to render observed judgment for events that occurred before their involvement in care.